Provider Demographics
NPI:1902185739
Name:SALIM, MAYNU MUHAMMAD (RPH)
Entity Type:Individual
Prefix:
First Name:MAYNU
Middle Name:MUHAMMAD
Last Name:SALIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 FINEO CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3052
Mailing Address - Country:US
Mailing Address - Phone:408-453-5131
Mailing Address - Fax:
Practice Address - Street 1:1709 AUTOMATION PARKWAY
Practice Address - Street 2:COSTCO PHARMACY #1004
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3052
Practice Address - Country:US
Practice Address - Phone:408-678-2159
Practice Address - Fax:408-678-2156
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist